Provider Demographics
NPI:1174563316
Name:HUBBARD, JEREMIAH A (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640580
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0580
Mailing Address - Country:US
Mailing Address - Phone:352-746-5707
Mailing Address - Fax:352-746-5944
Practice Address - Street 1:520 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4844
Practice Address - Country:US
Practice Address - Phone:352-564-2663
Practice Address - Fax:352-564-2615
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4814207X00000X
AZ1783207X00000X
MI5101008459207X00000X
WAOP-915207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82868ZMedicare ID - Type Unspecified
FLD60751Medicare UPIN